RESUMEN
We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010-2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40-60 were the most common demographic group in the cohort (48% of all patients), and men made up a high proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion which is somewhat smaller than what has been reported at non-VHA facilities, and despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits.
RESUMEN
INTRODUCTION: Domestic violence (DV) is a problem defined as physical, sexual, and/or mental abuse used by one person in a relationship in order to gain control over the other. This study aimed to investigate what victims of domestic violence are experiencing when they present to the emergency department (ED). METHODS: The survey was conducted during the women's initial visit to Sojourner Family Peace Center (SFPC) in Milwaukee, WI. It included 22 questions assessing women's encounters with screening and treatment for domestic violence in the ED. RESULTS: 24 surveys were collected over 7 months. Thirteen women presented for treatment of injuries related or not related to abuse. Problems with abuse-related care they received were identified. 31% of women presenting with obvious signs of abuse, such as human bite wounds or head injury, were not screened. Four of 11 women were screened with family or law enforcement present. Nine of 11 were screened by a nurse, social worker, or police officer, not a physician. Four women felt rushed by healthcare professionals and that they did not genuinely care. Most noticeably, women were not screened at all. CONCLUSION: DV screening must be done with no family present. Removing law enforcement from rooms is noted to make women feel more comfortable. If a family member is adamant about remaining with the patient, the patient can be removed for a blood draw or sensitive exam to attain privacy. Standardizing screening could aid in making DV victims feel less rushed and more at ease. The courageous women sharing personal stories help pave the way to better treatment for future victims of DV presenting to the ED.
